Before starting to study the Method, it is advisable to study at least in general terms the topology of the muscles and their functions. What are the main anatomical differences between the muscles of the body and face? Why are the facial muscles weaker?
Anatomically, the muscles and skin of the face are more closely connected than the muscles and skin of other areas of the human body.
Skeletal muscles, attaching to bones on both sides, cause them to move: moving in space, maintaining balance, moving limbs... Each muscle of the body has an antagonist muscle (eg biceps, triceps). Those. one muscle is responsible for one action, and the other for another. The facial muscles are different.
One muscle contracts, and in order to return to its normal state, it needs to relax. After all, the facial muscles are attached to the bones of the skull with only one end, and the other is woven directly into the skin of the face or mucous membrane. Hence, during contraction, a displacement of certain areas of the scalp occurs and thereby gives the face a variety of expressions and determines facial expressions. Such work does not require much strength, so the facial muscles are much smaller and weaker than the muscles of the body. (The exception is the masticatory muscles, which originate on the bones of the skull and are attached to the movable lower jaw and, accordingly, differ in strength from the rest of the facial muscles).
STUDY OF FACIAL MUSCLES (facial muscles, masticatory muscles, neck muscles)
The facial muscles are grouped mainly around the natural openings of the face (palpebral fissure, oral fissure, nasal openings, auditory openings). These holes, under the action of facial muscles, either decrease until completely closed, or increase, i.e., expand.
In accordance with this, all facial muscles are divided into 4 groups.
- I. Muscles of the scalp (muscles of the calvarium)
- II. Muscles of the eye circumference.
- III. Muscles of the mouth circumference.
- IV. Muscles of the circumference of the nose.
We will also be interested in the chewing muscles and neck muscles.
Let's take a closer look at each muscle
FAMILY (FACIAL) MUSCLES
I. Muscles of the scalp (muscles of the calvarium)
The entire cranial vault is covered by the thin supracranial muscle epicranius. It consists of:
extensive tendon ( Galea aponeurotica /2/) and the muscular part, which in turn is divided into three bellies: frontal, occipital and lateral.
Frontal belly of the supracranial muscle ( Venter frontalis /1/) starts right from the skin of the eyebrows. And its main function is to raise the eyebrow upward, making it arched. Exercise No. 3 to smooth out horizontal wrinkles strengthens it, lifts it and tones it, protecting the forehead from the formation of wrinkles.
II. Muscles of the eye circumference
Orbicularis oculi muscle ( Orbicularis oculi /3/). This is a powerful muscle that surrounds the entire orbit of the eye. It is divided into peripheral and internal parts.
When the eye closes softly, involuntarily, the inner eyelid part works, and when it contracts strongly, the eye closes.
Exercises No. 1 and No. 2 for the formation of beautiful eyes perfectly train this muscle, smoothing out fine wrinkles, reducing bags under the eyes, returning the eyes to the clear outlines and size they had in youth.
Eyebrow wrinkler ( Corrugator supercilii /4/).
The point of origin of the muscle is located on the frontal bone above the tear bone, and its other part is woven into the skin of the eyebrows. By contracting, it brings the eyebrows closer together and causes the formation of vertical wrinkles in the space between the eyebrows above the bridge of the nose. Exercise No. 4 to smooth out vertical wrinkles will allow your forehead to always remain strong and smooth.
III. Muscles of the nasal circumference
All muscles of the nose work in close interconnection. And during contraction, the cartilaginous part of the nose is compressed, the wing of the nose is lowered, and the cartilaginous part of the nasal septum is lowered.
Exercise No. 7 for the formation of a chiseled nose perfectly stimulates blood circulation and oxygen flow, making the nose clearly defined.
Muscle of the proud ( Procerus /5/)
This pyramid-shaped muscle crosses the bridge of the nose. It starts from the bony dorsum of the nose and ends in the skin, connecting with the frontal belly (venter frontalis). When contracted, it lowers the skin in the area where the brow ridges end, causing the formation of transverse folds over the bridge of the nose.
Nasalis /6/. Nasalis muscle
It starts from the tip of the nose and goes up, squeezing the nostrils.
Dilator nostrils posterior muscle.
Located near the edge of the nostril.
Function: widens the nasal opening so that more air can enter the lungs.
Dilator anterior muscle.
A thin, delicate muscle located just above the middle of each nostril.
Function: opens the nostrils, causing them to flare.
IV, the largest group. Muscles of the mouth circumference
Orbicularis oris ( Orbicularis oris /7/)
This muscle consists of muscle bundles located in circles in the thickness of the lips, around the mouth. Muscle fibers extend from it in various directions, connecting to the upper and lower lip, cheeks, nose and adjacent areas. Working with this muscle to one degree or another has a beneficial effect on all muscle fibers attached to it.
When the orbicularis muscle contracts, the mouth closes and the lips extend forward.
In the area of the cheekbones there is a large ( Zygomaticus major /8/) and small ( Zygomaticus minor /9/) zygomatic muscles
Both muscles move the corners of the mouth up and to the sides. The starting point is located on the zygomatic bone and upper jaw. At the point of attachment, the muscles intertwine with the orbicularis oris muscle and grow into the skin of the corner of the mouth.
Levator labii superioris muscle (Levator labii superioris /18/)
It starts from the infraorbital margin of the upper jaw and ends in the skin of the nasolabial fold.
By contracting, it raises the upper lip (snarling) and makes the nasolabial fold deeper.
Levator anguli oris muscle ( Levator labii anguli oris /17/)
When contracted, together with the zygomatic muscles, it moves the corners of the lips upward and to the sides. It is located under the levator labii superioris muscle and the zygomaticus major muscle and is attached to the corner of the mouth.
Buccal muscle ( Buccinator /10/)
This muscle is the basis of the cheeks and forms the rounded upper part of the cheek. It begins on the outer surface of the upper and lower jaw, and is attached to the skin of the lips and corners of the mouth, intertwined with the muscles of the upper and lower lips.
When contracted, it pulls the corners of the mouth back, promotes the sucking process, and also presses the lips and cheeks to the teeth, protecting the mucous membrane from biting when chewing.
Exercise No. 5 for the formation of beautiful and elastic cheeks allows this muscle to always be toned, and the cheeks to be round and clear.
Laughter muscle ( Risorius /11/)
This is a narrow transverse bundle of fibers that originates in the skin near the nasolabial fold and chewing fascia, and ends in the skin of the corners of the mouth. This is a non-permanent muscle and its task is to pull the corners of the mouth to the sides when smiling. In some people, when it contracts, a small dimple forms on the side of the corner of the mouth.
Muscle depressor labii inferioris ( Depressor labii inferioris /12/)
This muscle is covered by the depressor anguli oris muscle. It starts from the base of the lower jaw and is attached to the skin of the chin of the entire lower lip. When contracting, it pulls the lower lip down (facial expressions of disgust).
Muscle depressor anguli oris ( Depressor anguli oris /13/)
It begins on the lower edge of the lower jaw and is attached to the skin of the corner of the mouth and upper lip. When contracted, it pulls the corner of the mouth down and makes the nasolabial fold straight (gives the face an expression of sadness).
Mentalis muscle ( Mentalis /14/)
This is a tiny muscle on the front of the chin. It is partially covered by the muscle that depresses the upper lip and is attached to the skin of the chin from the alveolar eminences of the lower incisors and canines. When contracting, it lifts the skin of the chin upward, pushing the lower lip upward, pressing it towards the upper.
Masticatory MUSCLES (Masseter /15/.)
Thanks to these muscles, the act of chewing occurs. They have a movable point (attachment) on the lower jaw and a fixed point (origin) on the bones of the skull.
By contracting, they move the lower jaw up and forward. Exercises No. 6 for the formation of a clear oval of the face and No. 12 for the formation of elastic cheeks and a clear oval of the face perfectly work these muscles and help keep them in good shape. .
NECK MUSCLES
The neck muscles, covering one another, form three groups: superficial, middle and deep.
Superficial neck muscle ( Platysma /16/)
This is a wide, flat layer of muscle fibers that lie under the skin on either side of the neck. Extends from the lower part of the face to the collarbone. When contracting, it tightens the skin of the neck and partly the chest, lowers the lower jaw and pulls the corner of the mouth outward and downward.
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FACE (facies) - the anterior part of the human head. Conventionally, the upper border of the line runs along the line separating the scalp from the skin of the forehead; anatomical upper border of the facial part of the skull (see) - a line drawn through the glabella (bridge of the nose), the supraorbital edge of the frontal bone (brow ridges), the upper edge of the zygomatic bone and zygomatic arch to the external auditory canal. The lateral border of the L. is the line of attachment of the auricle at the back and the posterior edge of the branch of the lower jaw; lower - the angle and lower edge of the body of the lower jaw. The lateral and lower borders of the L. separate it from the neck area.
The shape and size of the lung, as well as its individual organs, are very diverse, which depends on race, gender, age, and also on individual characteristics. The outer contour of the leaf most often takes the form of an oval with a narrowed lower half, but often approaches the shape of a rectangle or trapezoid with rounded corners; it depends ch. arr. on the massiveness of the lower jaw and the width of its arch. The relief of the face and its profile are determined by the shape of the most convex areas - the forehead, brow and zygomatic arches, nose, chin, as well as the shape of the soft tissues of the lips and cheeks. There are regular relationships between the relief of the facial bones and the thickness of the soft tissue layer above them. The establishment of these patterns gave the basis to M. M. Gerasimov to develop and scientifically substantiate a system for restoring the external outlines of a face based on the shape of the skull.
The elasticity and turgor of the skin of the face and the degree of development of facial muscles determine the presence of more or less pronounced folds on the surface of the face, which are constantly present in every person (nasolabial, nasobuccal, geniolabial grooves). The contours of the face depend on the degree of fat deposition in the subcutaneous tissue, as well as on the presence and location of teeth and the relationship of the dentition (see Occlusion).
In the area of the lungs are the organs of vision - see Eye, the initial parts of the airways - see Nose, digestive tract - see Mouth, oral cavity, Lips, hearing organs - see Ear; the bulk of the bone base of the lung is made up of the upper and lower jaws (see).
Comparative anatomy
The material from which the skull of animals is built, including the anterior part of the head, is the mesenchyme around the brain and the gill arches (see Visceral skeleton). In the first land animals, the skeleton of the anterior section of the head had more bones than in the human skeleton. The dimensions of the anterior part of the animal skull are much larger than the dimensions of the brain; highly developed jaws protrude sharply forward. This situation persists down to the great apes.
In an orangutan, the ratio of the anterior and cerebral parts of the skull is equalized, but in humans, the front part of the head makes up only 30-40% of the brain part. The facial angle between the tangent from the forehead to the front teeth in profile and the base of the skull in an orangutan is 58°, in a human it is 88°. The pronounced prognathia of animals is replaced by the typical human orthognathia of L. (Fig. 1). The upright posture of primitive man played an important role in this. The transformation of the facial part of the head also occurred as a result of the development of the brain.
Amphibians and reptiles do not have facial muscles, but chewing muscles are developed. In mammals, facial muscles approach the upper and lower lips of the mouth, are distributed in the area of the nostrils, eye socket, and outer ear, due to which the skin in these areas is mobile, and the external openings of the nose, eyes and mouth can change shape. In humans, the masticatory muscles were noticeably reduced, and a high differentiation of facial muscles appeared, which ensured the variety and expressiveness of facial expressions. In the process of evolution, the convex brow ridges disappeared in humans, the eye sockets came closer together, a convex nose appeared, the mouth opening became smaller, and the mobility of the ears was lost. Accordingly, the ratios of the parts of the head also changed: the forehead increased, the jaws became smaller and began to protrude less and less (Fig. 2).
Embryology
The development of the human face is closely related to the beginning of the formation of the oral cavity. At the head end of the embryo, an invagination of the skin ectoderm appears, which grows towards the blind end of the head (fore, or gill) gut; an oral bay is formed - the rudiment of the primary oral cavity and the future nasal cavity. The oral bay is separated from the head intestine (the beginning of the anterior section of the intestinal tube of the embryo) by the pharyngeal (or oral) membrane, edges at the 3rd week. intrauterine life breaks through, and the oral bay receives communication with the cavity of the primary intestine. The initial section of the head intestine forms the gill apparatus, consisting of gill pouches, gill arches and slits. Its formation begins with the fact that the endoderm of the wall of the head end of the primary intestine forms protrusions - gill pouches; towards them, the ectoderm forms depressions (invaginations) - the so-called. gill slits. In humans, the formation of true gill slits (as in fish) does not occur. Areas of mesenchyme located between the gill pouches and slits form the gill arches. The largest is the first gill arch, called the mandibular (mandibular), from which the rudiments of the lower and upper jaws are formed. The second arch - the hyoid - gives rise to the hyoid bone. The third arch is involved in the formation of the thyroid cartilage. A skin fold grows from the lower edge of the second gill arch, the edges fuses with the skin of the neck, forming the cervical sinus (sinus cervicalis). Gradually, only the first gill slit remains visible on the surface of the embryo’s neck, the edges turn into the external auditory canal, and the auricle develops from the skin fold; when the cervical sinus is not closed, a fistulous tract remains on the child’s neck, which can communicate with the pharynx. The formation of the facial part of the skull (Fig. 3) is closely related to the development of the anterior part of the oral cavity and the nasal cavity from the oral bay. The oral (or intermaxillary) gap is limited by five ridges, or processes, which are formed by the first gill arch. Above the oral fissure there is an unpaired frontal process and on the sides of it the maxillary processes; below the oral fissure there are two mandibular processes, which are part of the mandibular (mandibular) arch.
In the lateral parts of the frontal process, two invaginations soon appear - olfactory fossae. In this case, the frontal process is divided into five processes: the central one retains the name of the frontal process, and the elevations surrounding the olfactory fossae turn into medial and lateral nasal processes. The olfactory pits are limited by the nasal processes that form the future nostrils. The primary nasal cavity, divided into two halves by the nasal septum, communicates widely with the oral cavity. The lateral nasal process is separated from the maxillary process by the nasolacrimal groove, which turns into the nasolacrimal canal (if it is not closed, the fetus is born with an open nasolacrimal canal).
The area of tissue separating the nasal passages from the oral cavity is called the primary palate; it subsequently gives rise to the definitive palate and the middle part of the upper lip. The lower portion of the frontal process and the maxillary processes form the orbit. The lower lip and chin are formed as a result of the fusion of the mandibular processes along the midline of the L.
The maxillary processes fuse with the mandibular processes in the lateral sections, forming the cheeks and lateral sections of the upper jaw and upper lip, but they do not reach the midline. The end of the frontal process descends into the space between them, from which the nasal processes extend. The middle part of the frontal process forms the nasal septum with the future premaxillary, or incisive, bone and the middle part of the upper lip.
At the 8th week. During the development of the embryonic orbit, the orbit is already turned forward, although between them there is still a wide part of the middle nasal process - the future external noe; at the same time, the dorsum of the nose is determined.
The human appearance of L. emerges at 8 weeks. The head of the embryo at this time is almost equal to the length of the body; the auricles are located very low in relation to other parts of the ear. During the formation of cartilage and ossification of the anlage of the bones of the brain and facial skull, the details of a developed face are formed. Thus, the forehead, the upper part of the orbit, the region of the nose and the middle part of the upper jaw and upper lip are formed from the frontal process; lateral sections
The l. are formed from the maxillary processes, the lower jaw - from two mandibular processes (Fig. 4). Violation of the processes of fusion of processes leads to the occurrence of developmental defects in the form of clefts.
Anatomy
Front part skulls human consists of paired bones - nasal (ossa nasalia), lacrimal (ossa lacrimaiia), zygomatic (ossa zygomatica), maxillary (maxillae), inferior turbinates (conchae nasales inferiores), palatine (ossa palatina) and unpaired - lower jaw (mandibula ) and vomer. In addition, processes or individual sections of the bones of the brain skull - temporal (ossa temporalia), frontal (os frontale), sphenoid (os sphenoidale) - take part in the creation of the bone base of the brain. All bones of the facial skeleton, except the lower jaw, are firmly connected to each other by bone sutures and are motionless relative to each other and the entire skull.
The lower jaw articulates with the temporal bones by two temporomandibular joints (see Temporomandibular joint), which act synchronously and ensure mobility of the lower jaw under the action of the masticatory muscles in the sagittal and transverse directions, as well as abduction and adduction of it to the upper jaw to perform the chewing function and speeches. The roots of the teeth are located in the alveolar process of the upper and alveolar parts of the lower jaw. In the thickness of the upper jaw are located the maxillary sinuses (sinus maxillares), communicating with the nasal cavity and forming, together with the frontal, sphenoid sinuses and the ethmoidal labyrinth, a system of paranasal sinuses (see).
In addition to bones, the skeleton of the lung contains cartilage (nasal, auricular); the size, shape and outline of the external nose and auricle largely depend on the structure of their cartilaginous framework.
Muscles L. are represented by two groups: more massive and powerful masticatory muscles (see) and facial muscles. In addition, from the point of view of function, the group of muscles that lower the lower jaw is included in the same group with the chewing muscles; they are attached to the inner surface of the body of the lower jaw and connect it to the hyoid bone and tongue. Topographically, these muscles do not belong to the L. muscles and are considered as the muscles of the floor of the mouth and the upper part of the neck.
Facial muscles(Fig. 5) are located more superficially and are woven into the skin at one end. They are formed by differentiation of the subcutaneous muscle of the neck (platysma), the edges are a rudiment of the broad subcutaneous muscle found in animals. Most of the facial muscles are located around the mouth, nose, eye and ear, participating to one degree or another in their closure or expansion. Sphincters (closers) are usually located around the holes in a ring, and dilators (expanders) - radially. By changing the shape of the holes, moving the skin to form folds, the facial muscles give the face one or another expression; This kind of facial changes is called facial expressions (see).
In addition, facial muscles take part in the formation of speech sounds, chewing, etc.
In the frontal region there is a thin frontal belly - part of the occipitofrontalis muscle (venter frontalis m. occipitofrontalis), which, when contracted, pulls forward the tendon helmet (galea aponeurotica), covering the cranial vault, and raises the eyebrows, forming a series of transverse folds on the skin of the forehead . A small area separated from this muscle and located along the bridge of the nose, when contracted, forms characteristic folds between the eyebrows and is called the proud muscle (m. procerus). The muscles that wrinkle the eyebrows (m. corrugator supercilii) are attached at one end to the nasal part of the frontal bone, and at the other they are woven into the skin of the eyebrows; when contracting, they bring the eyebrows closer together and lower their inner ends.
Around the orbit is the circular muscle of the eye (m. orbicularis oculi). When it contracts, it lowers the lower eyelid, pulls the skin of the cheek up and helps the eyelids close. The periodic reflex contraction of this muscle is known as blinking (see).
Around the oral opening in the thickness of the upper and lower lips there is the orbicularis oris muscle (orbicularis oris). Its constant tone ensures the closing of the lips; with a stronger contraction, the lips protrude forward and the mouth gap narrows; when relaxed, the lips and corners of the mouth can be pulled back by other muscles, which are woven into the orbicularis muscle in separate bundles.
The zygomatic major and minor muscles (mm. zygomatici major et minor), the muscle that lifts the upper lip (m. levator labii sup.), and the muscle that lifts the angle of the mouth (m. levator anguli oris), pull the upper lip and corner of the mouth upward and somewhat outward. The laughter muscle (m. risorius) pulls the corner of the mouth outward, widening the oral fissure. Under the action of the muscle that lowers the lower lip (m. depressor labii inf.) and the transverse muscle of the chin (m. transversus menti), the corner of the mouth and lower lip move down and out.
Small bundles of muscles that compress the nostrils (m. compressor nasi), dilate the nostrils (m. dilatator naris) and lower the nasal septum (m. depressor septi nasi), surround the nasal openings and give some mobility to the cartilaginous part of the nose.
The buccal muscle (m. buccinator) pulls the corner of the mouth outward, pressing the lips and cheek to the teeth. The buccal muscle is part of the lateral wall of the oral cavity. On the inside it is covered with a layer of fiber and the mucous membrane of the cheek, and on the outside it is in contact with the subcutaneous tissue, which forms the fatty body of the cheek (corpus adiposum buccae).
Fascia is present only in the lateral sections of the left leg. The temporal fascia (fascia temporalis) covers the temporal muscle. In the lower part it splits into two plates, which are attached to the outer and inner surfaces of the zygomatic arch. The fascia of the parotid gland and the chewing fascia (fascia parotidea et fascia masseterica) cover the parotid salivary gland from the outside and inside. The buccal-pharyngeal fascia (fascia buccopharyngea) covers the outer surface of the buccal muscle and behind it passes into the outer fascia of the pharynx, connecting to it with a tendon suture.
Skin on the face relatively thin, especially the skin of the eyelids; it easily moves above the layer of subcutaneous tissue in most areas, it is less mobile on the forehead and almost completely motionless on the surface of the nose, where there is almost no fat layer between the skin and cartilage of the nose. L.'s skin has many sebaceous and sweat glands. In women and children, in addition to eyebrows and eyelashes, there is vellus hair on the L.; in men who have reached puberty, long hair grows on the upper lip (mustache), in the parotid-masticatory areas, chin and lower lip (beard).
L.'s skin color is very diverse, which depends on race, age, age, general condition of the body and environmental conditions. A sharp change in the color of L. is observed in a number of pathols, conditions (pallor with anemia, fainting, yellowness with jaundice, redness with strong excitement and increased body temperature or blood pressure, cyanosis with poor circulation). Excessive pigmentation of L.'s skin is observed in some endocrine disorders (Addison's disease), during pregnancy (chloasma) and in a number of other cases.
Color rice. 1-3. Vessels, muscles and nerves of the face at different levels of section (I - superficial vessels and nerves of the face; II - vessels and nerves of the face; the masticatory muscle and part of the facial muscles are dissected; the temporal fascia is partially turned away; III - deep vessels and nerves of the face ; the zygomatic arch and part of the lower jaw were removed; the mandibular canal was opened; the masticatory muscle was turned away, part of the facial muscles and temporal fascia were removed): 1 - frontal belly of the occipitofrontal muscle; 2 - lateral branch of the supraorbital nerve; 3 - medial branch of the supraorbital nerve; 4 - supraorbital artery; 5 - supraorbital vein; 6 - orbicularis oculi muscle; 7 - arch of the upper eyelid; 8 - arch of the lower eyelid; 9 - angular vein; 10 - angular artery; 11 - transverse vein of the face; 12 - external nasal branch of the anterior ethmoidal nerve; 13 - zygomatic minor muscle; 14 - infraorbital artery; 15 - infraorbital nerve; 16 - zygomaticus major muscle; 17 - muscle that lifts the angle of the mouth; 18 - superior labial artery; 19 - facial vein; 20 - facial artery; 21 - inferior labial artery; 22 - orbicularis oris muscle (marginal part); 23 - muscle that lowers the angle of the mouth; .24 - mental artery; 25 - mental nerve; 26 - anterior belly of the digastric muscle; 27 - lower jaw; 28 - subcutaneous muscle of the neck; 29 - common facial vein; 30 - great auricular nerve; 31 - sterno-clavicular-mastoid muscle; 32 - submandibular vein; 33 - posterior belly of the digastric muscle; 34 - external carotid artery; 35 - chewing muscle; 36 - buccal muscle; 37 - cervical branch of the facial nerve; 38 - marginal branch of the lower jaw (facial nerve); 39 - parotid gland; 40 - buccal branches of the facial nerve; 41 - transverse artery of the face; 42 - zygomatic branch of the facial nerve; 43 - temporal branch of the facial nerve; 44 - external auditory canal (cut off); 45 - superficial temporal vein; 46 - superficial temporal artery; 47 - auricular-temporal nerve; 48 - temporal muscle; 49 - occipital artery; 50 - posterior auricular artery; 51 - facial nerve; 52 - buccal nerve; 53 - buccal artery; 54 - pterygoid plexus; 55 - chewing nerve; 56 - chewing artery; 57 - middle temporal vein; 58 - middle temporal artery; 59 - temporal fascia; 60 - zygomaticotemporal branch of the zygomatic nerve; 61 - zygomaticofacial branch of the zygomatic nerve; 62 - inferior alveolar nerve; 63 - inferior alveolar artery; 64 - lingual nerve; 65 - maxillary artery; 66 - deep temporal nerve; 67 - deep temporal artery; 68- zygomatic arch (sawed off); 69 - frontal branch of the superficial temporal artery; 70 - parietal branch of the superficial temporal artery.
Blood supply(color. Fig. 1-3) is carried out by the branches of the external carotid artery (a. carotis externa). The facial artery (a. facialis) enters the left side, bending over the edge of the lower jaw at the anterior edge of the masticatory muscle. Here it is easy to palpate and press against the jaw if it is necessary to temporarily stop bleeding in case of injuries to the left. During surgical interventions in this area, the possibility of damage to the artery should be taken into account. Making numerous bends under the skin of the face and in the thickness of the muscles, the facial artery is directed to the inner corner of the eye, where it anastomoses with one of the branches of the ophthalmic artery. Its branches going to the upper and lower lips (a. labialis sup. et a. labialis inf.), connecting with the same branches of the opposite side, form an arterial ring around the oral opening. Other branches supply blood to the muscles and skin of the midface.
The maxillary artery (a. maxillaris) gives numerous branches to various parts of the head. One of its branches - the infraorbital artery (a. infraorbitalis) - penetrates from the pterygopalatine fossa (see) through the lower orbital fissure into the orbital cavity, from where, through the infraorbital canal and foramen, it enters the anterior surface of the face, taking part in its blood supply. In the orbit, branches from this artery go to the alveolar process and the teeth of the upper jaw - the anterior superior alveolar arteries (aa. alveolares sup. ant.). The posterior superior alveolar arteries (aa. alveolares sup. post.) go to the posterior part of the alveolar process.
Another branch of the maxillary artery - the inferior alveolar artery (a. alveolaris inf.) - enters through an opening on the inner surface of the branch of the mandible into the canal of the mandible, supplying blood to the jaw and teeth; its final section, exiting through the mental foramen, is called a. mentalis. It participates in the nutrition of the soft tissues of the chin, anastomosing with a. submentalis - one of the branches of the facial artery.
The superficial temporal artery (a. temporalis superficialis) is the terminal branch of the external carotid artery. It passes through the thickness of the parotid salivary gland, exits under the skin in front of the auricle and supplies the parotid gland, the external auditory canal and the auricle with its branches. The transverse artery of the face (a. transversa faciei) departs from it to the buccal region, passing next to the excretory duct of the parotid salivary gland. Separate branches go to the temporal muscle and to the soft tissues of the forehead. The terminal branches of the ophthalmic artery (a. ophthalmica) from the internal carotid artery system are directed to the muscles and skin of the forehead and nose. These include the supraorbital artery (a. supraorbitalis), emerging together with the nerve of the same name from the orbit through the supraorbital foramen (foramen s. incisura supraorbitalis), the supratrochlear artery (a. supratrochlearis), emerging through the frontal notch - foramen and the dorsal nasal artery (a .dorsalis nasi), running along the back of the nose. The branches of the ophthalmic artery supply the eyelids and, anastomosing with each other, form the arch of the upper and lower eyelids (areus palpebralis sup. et inf.).
The posterior auricular artery (a. auricularis post.) takes part only in the blood supply to the auricle.
The venous network of L. is in general terms similar to the arterial one. The facial vein (v. facialis) accompanies the facial artery. It collects venous blood from most parts of the left leg. Veins flowing into it flow from the frontal, orbital and infraorbital areas, nose, eyelids, tonsils, cheeks, lips and chin. At the inner corner of the eye, the facial vein anastomoses with the nasofrontal vein (v. nasofrontalis), the edges flow into the superior ophthalmic vein (v. ophthalmica sup.), which communicates with the cavernous venous sinus (sinus cavernosus).
The posterior maxillary vein (v. retromandibularis) is formed as a result of the fusion of several temporal veins that have anastomoses with the frontal and occipital veins; it passes through the mass of the parotid gland behind the ramus of the mandible; small veins of the auricle, temporomandibular joint, middle ear, parotid gland, and cutaneous veins of the face flow into it.
Below the angle of the mandible, a vein from the pterygoid venous plexus (plexus venosus pterygoideus) flows into the posterior maxillary vein, where blood from the masticatory muscles, buccal region and walls of the nasal cavity collects; the pterygoid venous plexus communicates with the veins of the dura mater. The facial and posterior maxillary veins flow into the internal jugular vein (v. jugularis int.) at the level of the hyoid bone.
Lymphatic drainage. Lymphatic vessels form a branched network and carry lymph to regional lymph nodes (Fig. 6). The location of most lymphatic vessels corresponds to the course of the arteries; numerous superficial lymphatic vessels accompany L. arr. the maxillary artery and flow into the group of submandibular lymph nodes (nodi lymphatici submandibulares), located in the tissue of the submandibular region (submandibular triangle, T.). Lymphatic vessels from the frontal and temporal regions approach the postauricular nodes (nodi lymphatici retroauriculares). From the lower lip and chin, lymph flows into the submental nodes (nodi lymphatici submentales).
In addition, on the L. there are several smaller lymph nodes - superficial and deep parotid (nodi lymphatici parotidei, superficiales et profundi), located inside the capsule of the parotid salivary gland, buccal (nodi lymphatici buccales) and mandibular (nodi lymphatici mandibulares), located above the edge of the lower jaw at the border of the parotid-masticatory and buccal regions. From all of these nodes, as well as the cervical and occipital nodes, lymph collects in the lower part of the neck into the jugular lymph, trunk (truncus jugularis).
Innervation of the face(color fig. 1-3). Sensitive innervation of all organs and tissues of the leg is carried out by branches of the trigeminal nerve (see); motor innervation of the muscles of the leg from two sources: the masticatory muscles are innervated by motor fibers that are part of the third branch of the trigeminal nerve, facial muscles - by the branches of the facial nerve (see). The sensory organs located in the L. region transmit irritations perceived by the receptor apparatus to the central sections of the analyzers through the cranial nerves (olfactory, optic, vestibulocochlear).
Topographic areas
For the purpose of accurate topical diagnosis, it is customary in the clinic to subdivide L. into topographic areas (Fig. 7). There is a distinction between the frontal part of the frontal region of the head (regio frontalis) and the face itself, consisting of the following areas: the orbital region (regiones Orbitales), the nose region (regio nasalis, s. nasus ext.), the infraorbital region (regiones infraorbitales), the oral region (regio oralis), chin area (regio mentalis), cheek (regiones buccales), zygomatic (regiones zygomaticae), parotid-masticatory areas (regiones parotideomassetericae).
In the facial part of the frontal region, a distinction is made between the supraorbital, or superciliary, regions (regiones supraorbitales) and the glabella located between them - the glabella. In the orbital region, the area of the upper, outer and lower edges of the orbit (margo sup., lat. et inf. orbitae), upper and lower eyelids (palpebrae sup. et inf.) are distinguished. The nasal region is divided into the root (bridge), dorsum, apex, wings and nasal septum surrounding the external nasal openings (nostrils). In the infraorbital region, the fossa canina region is distinguished. In the zygomatic region, a distinction is made between the zygomatic bone (os zygomaticum) and the zygomatic arch (areus zygomaticus).
The boundaries between individual areas of the face coincide, as a rule, with the boundaries of the outer surfaces of the bones of the facial skeleton. The boundaries of some areas are natural skin folds (furrows): nasolabial (sulcus nasolabialis), chin-labial (sulcus mentolabialis); the border between the buccal and parotid-masticatory regions is determined by the anterior edge of the masticatory muscle.
Age characteristics
After the birth of a child, the forehead is lengthened due to the relatively high forehead, although transient birth deformation of the skull may also affect it. On average, the height of a newborn’s head is x/4 of the entire body length, while in an adult it is only 1/8 of the length. L. of a newborn is puffy, with wrinkled skin; the palpebral fissures are narrow, the eyelids appear swollen. The L. of a newborn correlates with the cerebral part of the head as 1: 8, in an adult - 1: 2 (Fig. 8). During the first two years of life, the height of the chin (the distance from the edge of the hair to the lower edge of the chin) increases on average from 39 to 80 mm. The forehead increases sharply, the jaws develop and enlarge, especially the lower one. Noe gradually acquires an individual shape due to the development of its cartilage and bones.
Gradually, the child’s face acquires a rounded shape, which is explained by the general rounding of the head, the rapid growth of the jaws, and the increase in fatty buccal lumps, which cause the convexity of the cheeks in children. The ratio of the brain and facial parts of the head is gradually approaching the proportion characteristic of an adult.
As the body ages, involutive changes in the jaw occur: teeth fall out, the alveolar processes of the jaws atrophy, the branches of the lower jaw become thinner, and the lower part of the jaw decreases (Fig. 9). The angle between the body and the ramus of the lower jaw becomes more obtuse.
L.'s skin loses elasticity earlier than in other parts of the body, collagen fibers become coarser, skin turgor weakens, skin folds increase, and wrinkles form. If a fat person loses weight, then the folds of the skin hang down, designated so-called. bags under the eyes.
In thin people in old age, the lip relief becomes more acute, the natural depressions increase due to the depletion of subcutaneous tissue in fat deposits, the lips become thinner, and the zygomatic arches protrude.
Pathology
Organs located within L. and their pathology are studied by special medical specialists. disciplines; Thus, diseases of the eyes, eyelids and muscles of the eyeballs are the subject of ophthalmology, diseases of the ear, nose and throat - otorhinolaryngology, diseases of the oral cavity, teeth and jaws - dentistry.
Developmental defects
An extremely rare developmental defect - the complete absence of L. - aprosopia. Isolated cases of absence of the middle part of the eye and nose have been described, in which the eyeballs merge together and are located in one common depression - the opium cycle. The complete absence of the lower part of the leg with the lower jaw (agnathia), combined with the approximation of the auricles, is also very rare. With defects of this kind, children are born unviable. Incorrect formation of L. is observed with craniofacial dysostosis (see), as well as with developmental anomalies and deformations of the upper and lower jaws (see Jaws).
An important wedge is one of the most common types of violations of the formation of L. - congenital clefts. According to numerous statistical studies, for every 600-1000 newborns, one is born with a cleft on the left side. Congenital clefts are the result of non-union of the embryonic tuberosities that form the left side of the embryo at an early stage of intrauterine development, but the reasons for this are not well understood. Apparently, they are a consequence of various external and internal effects on the fetus and patol, changes in the pregnant woman’s body; Hereditary predisposition plays a certain role. Sometimes L. clefts are combined with malformations of the tongue, skull bones, underdevelopment of the limbs, and congenital heart defects. Clefts of the upper lip and palate are observed in children with Robin's syndrome (see Robin's syndrome), in some cases - in children with Down's disease (see Down's disease) and Little's disease (see Infantile paralysis). However, in the vast majority of cases, L. clefts manifest themselves as isolated defects of embryonic development.
The shape and localization of the clefts (Fig. 10, 1 - 6) depend on which embryonic tubercles fusion has not occurred between. Median clefts of the lower jaw, formed due to non-union of the mandibular tuberosities, are the rarest type of clefts in the lower jaw (single cases have been described). Occasionally, traces of incomplete fusion are observed in the form of depressions in the middle section of the lower lip. Almost equally rare are oblique clefts of the left eye, formed in the absence of fusion between the maxillary and frontal tuberosities and running obliquely through the upper lip and infraorbital region to the lateral or medial corner of the eye. Somewhat more common are transverse clefts of the L. - non-union of the mandibular and maxillary germinal tuberosities, manifested in the form of a gap running transversely from the corner of the mouth through the cheek, which creates the impression of an overly wide mouth - the so-called. macrostoma; these clefts can be unilateral or bilateral.
The most common type of congenital defects of the upper lip is cleft lip, which is the result of nonunion between the lateral part of the upper lip, formed from the maxillary germinal tubercle, and its middle part, originating from the descended portion of the frontal tubercle. Cleft lips can be incomplete or complete (reaching the nasal opening), unilateral or bilateral.
A common type of birth defects of the palate is cleft palate; they can be isolated, but are often combined with clefts of the upper lip in the form of a through cleft passing through the lip, alveolar process of the upper jaw, hard and soft palate. With such combined clefts, especially bilateral ones, significant disturbances in the development of the upper jaw gradually occur, leading to severe deformation of the upper jaw. The middle section of the upper jaw - the incisive bone connected to the nasal septum and the vomer, without experiencing pressure from the orbicularis oris muscle, protrudes strongly forward, and the lateral the sections in front come closer together.
Treatment of children with congenital clefts should be comprehensive. In particular, surgical intervention is carried out early after the birth of the child, which ensures proper feeding (the third day after birth or the third month of life is considered the best time); in the future, orthodontic treatment methods are used (see), preventing and eliminating deformation of the jaws, and correcting speech defects. These and other activities, carried out in a certain sequence in the appropriate age periods, are the basis of the stomatol system, medical examination of children with congenital clefts of the lungs, carried out by specialized doctors and profs. institutions. Types of clefts and principles of surgical treatment - see Lips, Palate.
The presence of a congenital cleft lip or palate, especially if the operation is performed on time, as a rule, does not significantly affect the subsequent development of the child, both physical and mental.
Damage. With bruises on the leg, subcutaneous hemorrhages and hematomas are formed, which quickly resolve without special treatment, unless they are associated with fractures of the bones of the leg and a concussion or contusion of the brain.
Injuries
Minor superficial damage to the skin (abrasions, scratches) after smearing with an alcohol solution of iodine or brilliant green quickly epithelializes under the scab, usually leaving no noticeable scars. For deeper skin wounds, surgical debridement (see Surgical Debridement) and suturing (see Surgical Sutures) may be required.
Surgical treatment of L.'s wounds should be performed taking into account functional and cosmetic requirements. Excision of damaged tissue should be minimal; only completely crushed, obviously non-viable areas should be removed. When suturing wounds layer-by-layer, it is necessary to restore the continuity of the facial muscles; You should especially carefully stitch the edges of the leather, placing them in the correct position. Sutures on the skin should be applied with the thinnest atraumatic needle with a thread made of synthetic fiber (nylon, nylon); You should not allow tension on the skin when applying sutures; if necessary, you should separate it at the edges of the wound to make it easier to bring the edges together. Particular care is taken to connect the wound edges of the lips, wings, tip and septum of the nose, near the eyelids, eyebrows, and ears.
For wounds with tissue defects, when the edges of the wound cannot be sutured without tension, plate sutures are used to bring the edges of the wound closer together and reduce the volume of the subsequently formed scar. When surgically treating L. wounds with tissue defects, it is advisable to widely use primary plastic surgeries - plastic surgery with local tissues, pedicle flaps, and free skin grafts. For L. wounds penetrating into the oral cavity, it is necessary, if possible, to mobilize and stitch the edges of the mucous membrane in order to isolate the wound from the oral cavity. When treating wounds penetrating the maxillary sinus, the sinus should be inspected and a wide connection with the nasal cavity should be ensured, similar to radical surgery for sinusitis (see). When treating a wound with bone damage, only loose bone fragments are removed, and the fragments that have retained contact with the surrounding tissues are placed in place, covered with soft tissues. In case of jaw fractures, treatment of soft tissue wounds should be combined with immobilization of jaw fragments (see Splints, splinting, in dentistry). During further treatment, you need to take care not only of wound healing, but first of all of restoring the function and shape of damaged organs, using all means of complex treatment and rehabilitation (plastic surgery, dentofacial prosthetics, physical therapy, physiotherapeutic procedures).
Burns
For burns (thermal and chemical) and damage to L. tissue by electric current, first aid and treatment are carried out according to general rules, as with other localizations of these injuries (see Burns, Electrical trauma).
In peacetime, treatment of various L. injuries is carried out in dentists, departments of city and regional hospitals, as well as by dentists in regional hospitals and dentists, clinics.
Features of combat injuries, staged treatment
Based on the study of the experience of the Great Patriotic War, the following classification of combat injuries to the face has been proposed. 1. Gunshot wounds (bullet, shrapnel and others): a) soft tissue wounds; b) injuries with damage to the bones of the lower jaw, upper jaw, both jaws, zygomatic bone, and several bones of the facial skeleton at the same time. According to the nature of the damage, they are divided into: isolated (without damage to the facial organs and with their damage), combined with injury to other areas of the body, single, multiple, penetrating into the oral and nasal cavity and non-penetrating. 2. Non-gunshot wounds and damage. 3. Combined lesions. 4. Burns. 5. Frostbite.
Of all types of injuries, the most important are gunshot wounds, burns and combined injuries.
L.'s gunshot wounds amount to approx. 4% of all injuries. When nuclear weapons are used, the damage to the body in a significant number of cases will be combined (wound with burns, wounds with exposure to ionizing radiation, etc.). During the Great Patriotic War, according to the MSB, in 30-40% of cases of gunshot wounds of L. bones were damaged: of these, damage to the lower jaw was noted in 54.5% of cases, the upper jaw - in 26.9%, and both jaws - in 11 .6%, zygomatic bone - in 7% of cases. Of all types of injuries to L., burns accounted for 0.4%, non-gunshot injuries - 0.2%, combined injuries - 2.3%.
The wedge, picture and consequences of gunshot wounds of the soft tissues of L. are largely determined by the location of the wound. When the cheeks, lips and mouth are injured, significant swelling quickly develops, making it difficult to eat and impair speech. Damage to the lower lip and corner of the mouth, especially with tissue defects, leads to constant leakage of saliva, causing irritation and maceration of the skin. Extensive defects of the cheeks always lead to pronounced functional disorders, disorders and often to a severe general condition of the wounded, which is aggravated by difficulty in eating and drinking, speech disorders, and constant drooling.
With injuries to the submandibular region and the floor of the mouth, as a rule, an inflammatory process with severe swelling develops; such injuries are often accompanied by damage to the submandibular salivary gland and large vessels of the neck, larynx, and pharynx.
There are a variety of injuries to the nose (see), usually they are classified as severe injuries. When L. is injured, the tongue (see), hard and soft palate (see) is often damaged, with severe impairment of chewing, swallowing, speech, and sometimes breathing.
Wounds and damage to the lungs can be accompanied by a number of complications that arise both at the time of injury and at the stages of medical treatment. evacuation. It is customary to distinguish between early and late complications. Early complications include loss of consciousness, tongue retraction and asphyxia, bleeding, shock; to late - secondary bleeding, bronchopulmonary complications, osteomyelitis, abscesses and phlegmon, salivary fistulas, contractures, etc.
First aid on the battlefield and in areas of mass destruction (including in civil defense conditions) consists of the following measures: placing the wounded in a position on the stomach or side with the head turned towards the wound to prevent retraction of the tongue (see) and aspiration asphyxia (see); cleaning the oral cavity from blood clots, foreign bodies, loose bone fragments, applying a bandage from an individual dressing package; according to indications, immobilization of the lower jaw (see) using standard or improvised means, administration of painkillers. When removing and transporting the affected people, they are given a position that prevents the development of asphyxia.
First aid in the BMP: control and correction of bandages (bandages soaked in blood are bandaged), application of a standard splint (if it has not been applied before); to prevent asphyxia, fix the tongue with a safe pin, the edges are attached with a bandage to the neck; administration, according to indications, of painkillers.
When providing first aid in the primary care hospital, bandages and splints are monitored and, if indicated, corrected; if bleeding continues, the vessels are ligated or wounds are tightly tamponade. If the tongue and fragments of the lower jaw are displaced posteriorly, the tongue should be sutured with a silk ligature, stretching it to the level of the front teeth. The ends of the silk thread are attached to a special hook on the front side of a standard chin splint or to a gauze band tied around the neck. If the upper respiratory tract is blocked by a foreign body, a blood clot, or if the trachea is compressed by edema, hematoma or emphysema, immediate removal of the foreign body or urgent tracheostomy is necessary (see). In addition, anti-tetanus serum, antibiotics and, if indicated, painkillers are administered. The wounded are evacuated to the MSB (OMO).
In the conditions of civil defense, first medical care is carried out at the primary care facility to the same extent. However, for health reasons, surgical treatment is performed. Evacuation from the emergency room is carried out directly to a specialized department of the hospital base (see).
Qualified surgical care in the MSB (HMO) consists of the final stop of bleeding, elimination of asphyxia, bringing the wounded out of shock and, if necessary, surgical treatment of wounds.
In the MSB (HMO), the wounded with the most minor injuries are left in the recovery team; the lightly wounded (isolated soft tissue injuries without significant defects, fractures of the alveolar processes, damage to individual teeth, etc.) are sent to hospitals for the lightly wounded, the rest - to a specialized hospital.
Specialized treatment consists of surgical treatment of wounds, immobilization of jaw fragments using orthopedic and surgical methods, and, if appropriate, plastic surgery and dental prosthetics are performed.
The principles of surgical treatment of L. wounds for combat injuries are the same as in peacetime, i.e., functional and cosmetic requirements are taken into account. The high regenerative ability of tissues allows one to obtain favorable results in cases of surgical treatment of wounds at a later stage (48 hours or more after a combat injury). For large through defects of the soft tissues of the cheeks, the so-called suturing the wound, i.e., connecting the edges of the skin and oral mucosa with sutures (Fig. 11); this prevents the formation of scar deformities and contractures. In case of a wound combined with a L. burn, it is advisable to first clean the burned surface and insert a tampon into the wound. Then the burned skin is covered with sterile material and the wound is treated according to the usual rules. The wounds are closed with sparse stitches and drained with rubber strips. Burnt skin areas are treated openly. The granulating surface is closed by free skin grafting.
In case of combined radiation injuries, surgical treatment of wounds should be carried out as early as possible in order to achieve wound healing before the height of radiation sickness. In all cases, wounds must be closed with sutures. The use of dental splints for jaw fractures should be limited; Surgical methods for fixing fragments should be used. Wounds contaminated with radioactive substances are treated as radically as possible.
In the general complex of measures in the process of staged treatment of the wounded in Leningrad, nutrition and care are of exceptionally great importance (see Care, care for dental patients).
Diseases
A number of information diseases (scarlet fever, measles, typhus) is accompanied by a characteristic rash on the face and oral mucosa. Diseases of the skin of L. manifest themselves in the same way as in other areas of the skin of the body (pyoderma, dermatitis, eczema, lupus erythematosus, etc.); For L.'s skin, acne vulgaris and rosacea are specific, in men - inflammation of the hair follicles - sycosis (see).
Boils and carbuncles of L. in pathogenesis and wedge, picture in uncomplicated cases do not differ from boils and carbuncles of other areas of the body (see Carbuncle, Furuncle). However, due to the peculiarity of the outflow of blood, in some cases severe complications may arise in the form of thrombophlebitis of the facial veins, which is dangerous if it quickly spreads along the length of the veins; transfer of an infected embolus by hematogenous route and the formation of abscesses in various organs is also possible.
Of the specific inflammatory processes in L., skin tuberculosis (see), or so-called. ulcerative lupus of the face, leading to severe defects, and syphilis in all three stages. Hard chancre is relatively rarely localized in the area of the lips or corners of the mouth; with secondary syphilis, rashes on the skin of the nose may be observed. With tertiary syphilis, syphilitic gum is often localized in the bones of the septum and dorsum of the nose; as a result of its disintegration, a characteristic deformation is formed - the so-called. saddle-shaped noe (see Syphilis).
L.'s area is relatively often affected by actinomycosis (see). With anthrax (see), an early sign is the formation of necrotic papules on the face.
Tumor-like processes and tumors
On the skin of L. nevi are often detected (see), or so-called. birthmarks, sometimes occupying a significant surface of the skin of L. Birthmarks are smooth and convex; these are usually clearly demarcated pigmented areas of skin with uneven contours, pink, purple or brown, sometimes almost black; When pressed, the color of the spots does not change. The size of their surface may increase with age. Smooth birthmarks do not rise above the surface of the surrounding unchanged skin; convex - protrude above the skin level, they are soft to the touch, their surface is either smooth or dotted with thin grooves and papillary growths, often covered with thick hair. Nevi, especially pigmented ones, can be a source of malignant neoplasm (cancer, melanoma). Removal of small nevi, so-called. moles, can be carried out by freezing (see Cryosurgery) or diathermocoagulation (see). Extensive nevi must be surgically removed.
On the L. and neck in places where in the early stages of embryonic development there were cracks and furrows or folds of the ectoderm, cystic formations - dermoids (see); They are usually localized at the root of the nose, between the eyebrows, at the lateral and medial corners of the eye or closer to the temple, on the back and tip of the nose, on the cheek, near the wing of the nose, in the center of the cheek. Sometimes the dermoid reaches a large size; it is defined as a spherical or oval elastic formation in soft tissues or on a bone base; Unlike atheroma, the skin over the dermoid is mobile. Treatment is complete excision.
In L., vascular benign tumors often develop, arising on the basis of a congenital malformation of the circulatory or lymphatic systems. vessels. Skin hemangioma (capillary, cavernous) is usually detected from the moment the child is born; sometimes the tumor reaches a very large size, disfiguring the face; it has a lumpy surface, soft to the touch, usually painless (see Hemangioma). Benign tumor from lymph. vessels - lymphangioma (see) - has the color of normal skin. For the treatment of small vascular tumors, agents are used that lead to scarring and desolation of blood vessels (injection with alcohol solution of salicylic acid, lactic acid), freezing with carbon dioxide or using a cryoapplicator, interstitial electrocoagulation, radiation therapy. For tumors of significant size, surgical intervention is performed - suturing the thickness of the tumor or ligating the afferent vessels or excision of the entire tumor. lips (see), it is most often squamous with keratinization; Metastases can appear relatively quickly in regional lymph nodes, usually submandibular and submental. In L., melanoma can develop from some pigmented nevi (see). The wedge, the picture of L. skin cancer and melanoma and their treatment do not differ from the wedge, the picture and treatment of these tumors of other localization (see Skin, tumors). OK. 3% of all malignant tumors are cancer and sarcoma of the jaws. Malignant tumors of the parotid salivary gland - see Parotid gland.
Defects and deformations of the face can cause a variety of functions and disorders. Cicatricial narrowing of the oral cavity makes it difficult to eat and speak. Scar changes in the tissue between the upper and lower jaws lead to contracture of the jaws. The narrowing of the nasal openings interferes with breathing. Defects and cicatricial inversions of the eyelids, disrupting their closure, lead to hron, inflammation of the membranes of the eye. Defects in the lip, cheek, and chin lead to constant leakage of saliva, disturbances in eating and speech. Defects and deformations of the upper and lower jaw, ankylosis of the temporomandibular joint sharply reduce the function of chewing, which affects the activity of all organs of the digestive system. However, not only functional disorders are indications for the elimination of defects and deformations of the leg; the cosmetic factor is of great importance.
The size, shape and localization of L. defects and the condition of the tissues surrounding them depend on the cause that led to the formation of the defect. In case of L. defects as a result of injury, severe disfigurement is observed not so much due to loss of tissue, but due to their frequent fusion in a displaced position due to inadequate surgical treatment of wounds. Massive contracting scars are formed after the healing of L. wounds that were not closed in a timely manner by suturing, or if early plastic surgery was not performed.
With gunshot wounds, especially from fragments of mines, artillery shells and aerial bombs, significant defects occur in the lungs, with damage to the integrity of both soft tissues and bones. And the size of the defect and the nature of the cicatricial changes in the surrounding tissue depend on how carefully and timely the surgical treatment of the wound was performed. Extensive injuries, especially with separation of sections of the left leg, are very difficult for the patient, and also pose great difficulties for treatment and subsequent plastic surgeries.
When the relief of the face changes, associated with defects and deformations of the jaws and other facial bones, surgical intervention is necessary on these bones to restore their continuity and symmetry of the external contours. For this purpose, osteoplastic operations on the jaws (see), replanting of cartilage or implants (see) from synthetic polymer materials on the surface of the bones are performed. If the layers of soft tissue are asymmetrical, either their excess is excised or tissue is transplanted into the area of retraction.
Cicatricial changes in L. tissue after burns depend on the size of the burned area and hl. arr. from the depth of the burn. First degree burns, as a rule, do not leave scars; sometimes after them the color of the skin of the affected areas changes. After II-III degree burns, flat, often atrophic scars can form, impairing the mobility and texture of the skin. IIIb degree burns are characterized by the formation of scar tissue, leading to eversion and displacement of moving parts of the face - eyelids, lips, corners of the mouth. With deeper burns (IV degree), when not only the skin is affected, but also the subcutaneous tissue and muscles of the lung, powerful immobile scars are formed, often of a keloid nature (see Keloid). The consequences of burns in which the skin-cartilaginous areas of the nose and ears are destroyed are especially severe, both cosmetically and functionally.
Defects formed during tuberculosis of the skin of L. (ulcerative lupus) are localized within the cutaneous-cartilaginous part of the nose and upper lip. Only in particularly severe cases do the tissues of the entire middle part of the lip die: in this case, total defects of the nose, upper and lower lips, and the perioral part of the cheeks are formed. The scars along the edges of the lupus defect are thin and soft; however, cicatricial changes often spread far beyond the defect, affecting adjacent areas of the skin. Defects of the wings, tip and septum of the nose are typical; they are accompanied by gradual atresia of the external nasal openings. Tuberculous lesions of the skin of the mouth area result in cicatricial deformation of the lips and narrowing of the oral opening (microstomy). Plastic surgery after lupus can be started no earlier than a year after the end of treatment in the absence of relapse of the disease.
Defects resulting from syphilis are most often localized in the nasal area, but, unlike lupus, it affects the bony part of the nasal dorsum and septum, which is manifested by retraction of the nasal dorsum or a defect in its middle section. The scars around the syphilitic defect are thin and atrophic; the skin of the surrounding areas is not externally changed, although the ability to regenerate is reduced. Reconstructive operations are undertaken after completion of treatment and serol control for a specified period.
To replace L. defects after removal of tumors, primary plastic surgery is increasingly performed directly during the removal of a benign neoplasm; During the removal of malignant tumors, primary plastic surgery is not indicated. Plastic surgery in patients after removal of malignant tumors should begin after a sufficient period of time has passed so that a conclusion can be made about the absence of metastases and early relapses.
L.'s defects after noma are often very extensive, covering the areas of the corner of the mouth, upper and lower lips and cheeks, and often almost all the soft tissues of the lateral or lower part of the face (cheek, mouth area, lower lip). Along the edges of such a defect, powerful scars are formed, often of a keloid nature. The contraction of the jaws by scars leads to persistent contracture and subsequent severe deformities of the bones of the facial skeleton. These defects are especially difficult for plastic replacement, which is associated, in addition to the extent of the damage and the depth of scar tissue changes, with a sharp decrease in the regenerative characteristics of the body for many years after the disease; With modern treatment methods, extensive defects after noma are extremely rare.
L.'s deformation, i.e., a change in its outline without violating the integrity of the integument, may be the result of either a change in the shape of the bone or cartilaginous support, or a deviation from the normal thickness of the soft tissue layer; L. deformations also occur with paresis and paralysis of the facial nerve (see) due to loss of tone of the facial muscles. Very rarely, deformation of the left leg is observed, associated with trophic disorders, for example, with progressive hemiatrophy (see) - a disease expressed by gradual thinning of the soft tissues and atrophy of the bone skeleton of one half of the left side. Hypertrophy of individual areas of the left side occurs in the form of excessive development of one of the jaws - upper (prognathia) or lower (progeny, macrogeny); much less often, an increase in all the bones of the facial skeleton is observed, for example, with acromegaly (see). A rare disease - bony lionism of the face (see Leontiasis ossea), manifested by excessive growth of all facial bones, is considered by some authors as a hypertrophic process, but there are more reasons to attribute it to patol. bone lesions such as generalized fibrous osteodystrophy.
L. defects, in addition to those formed as a result of wounds and diseases, include nevi, hyperpigmentation of the skin, for example, chloasma (see), hypertrichosis (see), etc., as well as wrinkles, especially those formed prematurely.
Sometimes, even in the absence of any patol changes, the natural shape of individual parts of the flap may not satisfy aesthetic requirements. For such defects, as well as to remove excess skin and subcutaneous tissue and eliminate folds and wrinkles of the cheeks, eyelids, and neck, cosmetic surgeries are performed using specially developed techniques. Cosmetol. assistance is provided by cosmetic surgeons at cosmetology. hospitals.
Principles of facial plastic surgery
Deformations and defects of the lip of various origins and nature can be more or less completely eliminated by plastic surgery. The success of plastic surgery, including L., depends primarily on their clear planning, based on an analysis of the defect and the possibilities of its elimination. The restorative treatment plan should include the selection of material for replacing the defect and methods of its use, carrying out preparatory measures - general and special dental (sanitation of the oral cavity, manufacturing of orthopedic equipment, prosthetics), establishing the sequence, timing and methods of all stages of surgical intervention and subsequent rehabilitation.
The main methods of plastic surgery of soft tissues of L. are plastic surgery with local tissues, plastic surgery with pedicled flaps, the use of a Filatov stalked flap, and free tissue transplantation. The principles of using these methods are borrowed from general reconstructive surgery. Special techniques are determined by the peculiarities of the structure and function of the organs being restored and cosmetic considerations.
Plastic surgery with local tissues is the most advanced method of eliminating soft tissue defects of the face. Its advantages: cosmetic - the greatest similarity of the skin in color and structure; functional - preservation of the innervation of the flap, the possibility of including muscle bundles and mucous membrane in it; operational and technical - relative simplicity and speed (single-stage) implementation. Plastic surgery with local tissues is not feasible in case of extensive defects and the presence of deep scar changes.
The main method of plastic surgery with local tissues - moving opposing triangular flaps - was comprehensively developed by A. A. Limberg. The advantage of this method is the possibility of accurate objective planning of operations. This method is especially valuable for eliminating scar tissue shortening, skin tightening, eliminating or forming skin folds, and for restoring the position of displaced areas of facial tissues and organs.
Plastic surgery of pedicled Pi flaps, which was previously widespread in L. operations, is used less frequently in modern clinics. This is explained not so much by the shortcomings of this method, but by the successful development of other methods - plastic surgery with local tissues and the use of Filatov stem. Only a few surgeons use flaps from the scalp on a pedicel in the temporal region to close defects in the oral region in men according to Lexer-Frankenberg, extensive flaps from the neck to replace defects of the cheek and about Almazova and Israel; The so-called ones have almost completely fallen out of use. Indian and Italian methods of rhinoplasty and the so-called. biological Esser flaps with a pedicle including an artery; however, in some cases their use may be advisable.
Plastic surgery with Filatov's stalk flap. Filatov's stalked flap is increasingly used in all cases where it is not possible to eliminate a defect in L. tissues with plastic surgery using local tissues. The Filatov stalk is most often formed on the lateral surface of the abdomen and lower chest on the left. Less commonly, for extensive defects of the left shoulder, shoulder flaps are used in men, and in cases where a very small amount of tissue is required, flaps formed on the anterior surface of the left shoulder are used. The Filatov stem should not be formed in women on open areas of the neck or on the front surface of the chest. Migration of the stem from the abdomen to the left hand is accomplished by suturing its stem to the distal third of the forearm or to the left hand. Transfer of the stem to the L. is planned in such a way as to avoid additional steps and immediately ensure engraftment of the stem to the edge of the defect. The use of a Filatov stem to replace a defect is a particularly important stage of treatment (see Skin grafting).
The discrepancy between the color and structure of the skin of the transplanted stem and the surrounding areas of the leaf is subsequently eliminated by removing, using a knife or a cutter rotated by a drill, a layer of skin containing pigment in the area replaced by the stem. The wound surface quickly epithelializes, and the skin takes on a color similar to neighboring areas.
Ensuring the mobility of L. sections formed from the Filatov stem is a complex and not yet resolved problem; sewing bundles of facial muscles cut off from the place of attachment into a flattened stem does not always give the desired effect.
Free tissue transfer. Of the numerous methods of free skin grafting common in modern surgery, not all are used in reconstructive operations of the facial area. Transplantation of small pieces of skin or epidermis, skin islands, is unacceptable on L. for cosmetic reasons, since this creates an uneven surface and the skin has a marbled appearance. For the same reasons, transplantation of thin skin flaps is not used.
However, this type of skin grafting is used to replace defects in the mucous membrane of the oral and nasal cavity. The so-called transplant. split skin flaps, which are taken using a dermatome, provide the best engraftment with a satisfactory cosmetic result and are especially convenient for covering large wound and granulating surfaces on the left leg and head. The use of this method made it possible to abandon all kinds of perforated flaps and pressure-regulated dressings and minimize the cases of necrosis of skin autografts. The best cosmetic effect is obtained by transplanting full-thickness skin flaps; It is preferable to perform it for L. skin defects of small extent, for example, after excision of scars and birthmarks.
Free transplantation of soft tissues other than skin is performed much less frequently. A very unstable result is obtained by transplanting fiber containing fat to eliminate deformation of the left leg. This is due to the inability of fat to retain its given shape and its inevitable resorption. A slightly better result can be obtained by transplanting areas of subcutaneous tissue along with skin devoid of epidermis. They finally abandoned the introduction of paraffin into the tissue to eliminate deformation.
Rarely, free transplantation of strips of fascia is performed, for example, to suture a displaced corner of the mouth in case of facial nerve paralysis, to create an interosseous spacer during osteotomy of the lower jaw for ankylosis of the temporomandibular joint.
Cartilage transplantation is quite widely used to replace supporting tissues on the left leg. Cartilage taken from a patient (autoplasty) or cartilage preserved in various ways from fresh corpses (alloplasty) is used. Cartilage is introduced either in the form of separate grafts modeled with a knife, or in crushed form (so-called minced cartilage); A method has been developed for introducing finely ground cartilage without skin incisions - through a thick injection needle from a special syringe. Replacement is also used to correct the contours of the supporting tissues of L. implants made of synthetic materials - plastics; Such implants are made using a wax model.
Free bone grafting (bone grafting) is the main method for eliminating defects and false joints of the lower jaw.
In some cases, due to the unsatisfactory general condition or advanced age of the patient, as well as the reluctance to undergo surgical interventions, facial ectoprostheses, or prostheses of individual organs of the face - the nose, the auricle, are used to close the defects of the lip. Such dentures are made of elastic plastic and fixed to the tooth with glue or spectacle frames (see Dentures).
Methods of surgical restoration of individual organs and parts of the lip - see Blepharoplasty, Lips, Otoplasty, Rhinoplasty, Jaws.
Bibliography: Arzhantsev P. 3., Ivashchenko G. M. and Lurie T. M. Treatment of facial injuries, M., 1975, bibliogr.; B er-nadsky Yu. I. Fundamentals of surgical dentistry, Kyiv, 1970, bibliogr.; He. g e, Traumatology and reconstructive surgery of the maxillofacial region, Kyiv, 1973; Gorbushina P. M. Vascular neoplasms of the face, jaws and oral cavity organs, M., 1978, bibliogr.; Evdokimov A.I. and Vasiliev G.A. Surgical dentistry, M., 1964; Kabakov B. D. and Rudenko A. T. Nutrition of patients with trauma to the face and jaws and care for them, L., 1977: Kabakov B. D. et al. Treatment of malignant tumors of the maxillofacial region, M., 1978, bibliogr .; Cosmetic operations of the face, ed. N. M. Mikhelson, M., 1965; K r u h i n s k i y G. V. Complex transplants in facial plastic surgery, Minsk, 1978, bibliogr.; Limberg A. A. Planning of local plastic operations on the surface of the body, L., 1963; Mikhailov S.S. Anatomical foundations of facial tomography. M., 1976, bibliogr.; M and h e l with about N N. M. Restorative operations of the maxillofacial region, M., 1962, bibliogr.; Mukhin M.V. Treatment of burns of the head, face, neck and their consequences, “, 1., 1961; Operative maxillofacial surgery, ed. M. V. Mukhina, L., 1963; Experience of Soviet medicine in the Great Patriotic War of 1941 -1945, vol. 6, M., 1951; Guide to surgical dentistry, ed. A. I. Evdokimova, M., 1972; Handbook of medical cosmetics, ed. A. F. Akhabadze, M., 1975; Textbook of military maxillofacial surgery, ed. B. D. Kabakova, L., 1976; Goodman R. M. a. Gorlin R. J. Atlas of the face in genetic disorders, St. Louis, 1977.
V. F. Rudko; B. D. Kabakov (military), V. V. Kupriyanov (comparative an., embr.).
As the popular saying goes: “The face is the mirror of the soul.” It is important for a woman that it be beautiful. And beauty, first of all, depends on muscle tone. That is, in order to preserve beauty for many years, the facial muscles need to be trained. And here their anatomy and structure and their knowledge are important for the correct execution of exercises.
Anatomy of facial muscles
Before you start doing facial gymnastics (face forming, face building, bodyflex and facial aerobics), it would be a good idea to study the anatomical structure of the cervical and facial muscles.
There are more than 100 muscles in the head and neck. They are divided into several main groups:
- Oculomotor.
- Chewing, oral cavity, tongue.
- Mimic.
- Neck and areas close to it.
But this division into groups is conditional, because the same ones can be classified into several groups at once.
Chewing and facial muscles and their functions
If we divide the facial muscles according to their distinctive features, then there are two main groups:
- chewers, which move the lower jaw and participate in the chewing process;
- facial expressions that change facial expression under the influence of emotions.
The main difference between these groups is that the mimic ones are attached to the bone on one end, and to the skin or other nearby muscles on the other. Chewable ones are attached to the bones at both edges.
When the chewing muscle contracts, you can see a slight relief, because they have a fairly voluminous muscular part. They participate not only in chewing, but also in conversation, and also a little in facial movements.
Mimics have absolutely no visible relief. They do not move by increasing or decreasing in size. They simply move skin structures such as the lips and eyelids and move the skin.
Movement of facial muscles
The outlines of the nose, eyes and mouth change depending on emotions: anger, fun, sadness, pain. In addition to emotional stimuli, external sensations can influence facial expressions. For example, cold or warm. Olfactory, auditory, gustatory, visual stimuli or a complex of them are also imprinted on the face.
But the anatomy of muscles is interesting because they react differently in all people. It depends on the person’s upbringing and character. They may not react at all, hiding a person’s feelings and emotions. They may react with restraint or reflexively.
If you study their movement and learn to control them, or even more, manage them, then you can easily hide your emotional state from others. Or, with the help of special exercises, make a transformation apparatus out of them. This is actively used by theater and film actors.
You can use photo materials to study. But practical familiarization will be much more effective. To do this, you need to study your own face in front of the mirror. At the same time, note what changes in the face are caused by this or that muscle. Thus, first one tenses and the changes are recorded. In this way, the individual action of each muscle is gradually studied. And only after this can their combined effect be studied.
Age-related changes
Over time, the muscles of the neck and face become deformed. Most often, they narrow and decrease in volume. Their tone also weakens. The consequence of this is a drooping of facial features. For example, bags under the eyes occur due to sagging muscles located in the eye area. Therefore, not only extra pounds, but also weak neck muscles are to blame for the presence of a double chin.
They need to be trained using special gymnastics. With constant exercise, the tone increases and they tighten. As a result, the face becomes more toned and fresh without the intervention of surgeons.
There is a big difference between plastic surgery and facial gymnastics. Surgeons are already working with the results of age-related changes. Face gymnastics exercises are aimed at strengthening muscles. And this gives a more sustainable result for a long time. Therefore, you should not wait for the first wrinkles to start training your facial muscles. It will be much more effective to keep them in good shape from a young age.
The muscles of the head are a fairly important topic in the first anatomy course. It is necessary to know them as an integral part of myology, firstly. And secondly, some of the masticatory and facial muscles will become excellent topographical landmarks for you when you study the vessels and nerves of the head.
Let's start, of course, with the main classification. All head muscles are divided into two groups:
- Mimic. First of all, they form the expression of our emotions – facial expressions. Also, facial muscles are involved in some protective reflexes (blinking, for example), and, in part, help articulation;
- Chewable. Their main purpose is to control the movements of the lower jaw to chew food and open the mouth. Also, the masticatory muscles partly help with articulation.
Before we begin to analyze each muscle, it is necessary to consider the most important features of the facial muscles, there are three of them.
- Facial muscles do not have fascia;
- The facial muscles are attached directly to the skin;
- The facial muscles are located around the natural openings of the face.
The most convenient order for studying facial muscles is to move from top to bottom, that is, from the forehead to the chin, focusing, of course, on the natural openings of the face - eyes, nostrils, mouth.
Anatomy of facial muscles
Let me make a reservation right away that I will talk about the most basic muscles. You can complete what your teachers require from you in full, knowing the basics. But it is impossible not to know the muscles that we will now discuss, no matter what medical university you study at.
I. Epicranial muscle(musculus epicranius). It has a very wide supracranial aponeurosis (aponeurosis epicranialis), which connects its upper part with the scalp (tight connection), and its lower part with the periosteum of the skull (loose connection). Also, the supracranial muscle has two bellies - the frontal (venter frontales) and the occipital (venter occipitales).
The frontal belly begins from the supracranial aponeurosis and is attached to the skin above the eyebrows. That is why we classify the supracranial muscle as a facial muscle. The occipital abdomen is located from the superior nuchal line of the skull to the posterior part of the supracranial aponeurosis.
Look, both the aponeurosis and both abdomens are very clear on any tablet. I marked the frontal abdomen in blue, the occipital abdomen in red, and the aponeurosis itself in green. 
Function: the occipital belly of the supracranial muscle pulls its entire mass towards itself, thus the scalp moves slightly backward. When the frontal abdomen contracts, it pulls the supracranial muscle toward itself. If the frontal abdomen contracts and the supracranial aponeurosis is fixed, then the eyebrows will rise. The most mimic muscle there is.
II. Let's go down just below the forehead and see orbicularis oculi muscle(musculus orbicularis oculi), it is very visible. It is large, and, true to its name, literally surrounds the eye. The orbicularis oculi muscle consists of three parts:
- The secular part (pars palpebralis). If you close your eyes, your eyeballs will be covered with eyelids. This, in general, is the age-old part of the orbicularis oculi muscle. Its function is to close the eye with the eyelid;
- Orbital part (pars orbitalis). The largest part of the orbicularis oculi muscle. It seems to surround the eye, the secular part and, of course, the lacrimal part. When this part of the muscle contracts, it closes the eye tightly, straining the skin around it;
- Lacrimal part (pars lacrimalis). Not noticeable from the outside, located in the lower medial corner of the eye. The lacrimal part opens the lacrimal sac and drains tear fluid into the lacrimal canaliculi.
Now let's look at all three parts on the tablet. I highlighted the orbital part in blue and the eyelid part in green. Remember that the eyelid part is the eyelids themselves, and that the eyelid part is always located inside the orbital part, do not confuse them. 
The lacrimal part is not visible in the unprepared eye. But the approximate location of this part is: 
III. Muscle of the proud(musculus procerus). A very cool Latin name, one of my favorite sounds. However, it is very strange (for me, at least). Let's first find this muscle on our tablet: 
And one more picture from Wikipedia, I can’t help but post it - it’s just beautiful. 
And now about the strangeness in the name, it is directly related to the function of this muscle. The name “proud muscle” evokes in my mind something that forces the head to fall back, raising the chin. However, the muscle we are looking at now causes a completely different movement. The pride muscle creates a frowning facial expression with vertical folds of skin between the eyes. It is the muscle of the proud that creates the facial expressions of the great Joseph Brodsky in this photo: 
IV. Nasalis muscle(musculus nasalis). The muscle is notable for having a tendon. It is approximately in the area of this tendon that the proud muscle begins and goes upward towards the forehead. But we digress.
The nasal muscle starts from the upper jaw in the area of the roots of the lateral incisor and canine. This is an important point, do not show it on the tip of your nose. This is a fairly common mistake. Then the nasal muscle rises a little upward and passes into the tendon. If you look just above the tendon, that is, rise from the bridge of the nose towards the forehead, you will see that very muscle of the proud.
Here is the nasal muscle in a wonderful illustration from Wikipedia. You can very clearly see how, rising up and towards the center, it turns into a white aponeurosis: 
Well, on our tablet I also decided to designate it: 
The nasal muscle is represented by two parts - external and internal. I decided not to highlight them on the tablet, since it would be difficult to show the internal ones.
- The outer part, also known as the transverse part (pars transversa), goes around the wings of the nose from the outside and passes into the aponeurosis;
- The inner part, also known as the wing part (pars alaris), goes around the wings of the nose from the inside and is attached to the cartilage.
Both parts act interconnectedly, performing one function, namely, a slight compression of the nasal opening.
V. Orbicularis oris muscle(musculus orbicularis oris). Do not confuse with musculus orbicularis oculi, that is, the circular muscle of the eye. In my group, most students were sent to retake the test in myology precisely because of this error; the Latin terms are very similar. Musculus orbicularis is a repeating prefix, it translates as “circular muscle.” And to it we add the word oculi (association - “ocular”, “eye”), that is, eye, or the word oris (association - “oral”, “oral”, i.e. through the mouth) - mouth.
So, now about the muscle itself. It is divided into two parts - labial (pars labialis) and marginal (pars marginalis). The labial part is the actual visible tissue of the lips. The marginal part is a large circle, inside of which there is a labial part. I decided to show the orbicularis oris muscle on this tablet, it fits perfectly in my opinion. I marked the lip part in blue, and the edge part in green. 
The marginal part extends the lips into a tube.
When contracted, the labial part tightly closes the oral opening. The mouth is closed with tightly closed lips. I couldn’t find a picture where only the labial part was involved, alas.
VI. Buccal muscle(musculus buccinator). Large facial muscle, occupies a large space on the face.
As you can see, the buccal muscle above and below starts from the outer surfaces of the upper and lower jaws, respectively, and medially intertwines with the orbicularis oris muscle. It is quite easy to determine on any tablet, but I preferred the picture from Wikipedia. Here the upper and lower jaws are marked in white: 
The buccal muscle, with bilateral contraction (that is, when both the left and right muscles work), presses the cheeks to the teeth, pulling them inward; with unilateral contraction, the muscle pulls the corner of the mouth to the lateral side.
You need to understand that the buccal muscle has an internal position; on top it is covered by more superficial facial muscles, such as the zygomatic muscles (major and minor), as well as the masseter muscle. In addition to this, from the outer surface the buccal muscle is covered by the fatty body of the cheek (corpus addiposum buccae ). I marked the cheek muscle itself in red, and the fat pad in blue. 
The author's name for this formation is “Bisha's fat lumps.” The cheek fat pad is especially developed in infants; it forms the rounded contours of the cheeks. 
VII. (musculus zygomaticus major/musculus zygomaticus mitor). Very simple muscles to find on any tablet. If you know where the zygomatic bone is located, then finding the two zygomatic muscles will not be difficult for you. It is from the anterior surface of the zygomatic bone that these two muscles begin. Look how clearly they are visible in our main image: 
True, there is a peculiarity here. On our tablet, you can get confused trying to distinguish the zygomaticus minor from the major muscle. Remember the rule - the zygomatic minor muscle is always closer to the eye.
The algorithm for finding the zygomatic muscles in pictures, on tablets, and on preparations is the same - first we find the zygomatic bone, immediately we find two long muscles similar to each other on it, and the one closest to the eye is the zygomatic minor, and the one closest to the eye is the zygomatic minor, and that the far one is the zygomaticus major muscle. 
The zygomatic major muscle is woven into the orbicularis oris muscle, and the minor muscle connects to the skin in the area of the nasolabial fold.
Now all that remains is to parse the function. Both muscles work harmoniously, performing similar functions. The zygomaticus major muscle pulls the corners of the lips upward and laterally. The small one also pulls the corners of the lips upward, outlining the contours of the nasolabial fold. Imagine that you are a wolf and you need to scare someone. Expose the upper row of teeth, imitating a grin, while leaving the lower lip in place - you will get an illustration of the work of these two muscles.
Of all the pictures on the Internet, I liked this one the most: 
The vampire girl’s lips are pulled upward and slightly laterally, and there are also defined nasolabial folds (the one to our left is especially clearly visible, the light falls on it). An excellent illustration of the work of the zygomatic muscles, I think.
VIII. Ear muscles - anterior, middle and posterior. Based on topography, these muscles should have been on my list between the supracranial and orbital muscles (we move from top to bottom, as you remember). But I decided to put the ear muscles at the end of the list - they are vestigial, that is, left to people as an inheritance from their distant animal ancestors.
These rudimentary muscles became unnecessary in the process of evolution, so in most people they are not developed at all. However, during the myology test, questions about them may be asked, so let’s look at them too.
- Anterior ear muscle (musculus auricularis anterior). It starts from the temporal fascia and supracranial aponeurosis, and is attached to the skin of the auricle just above the anterior cartilage. To put it very simply, this muscle lies between the auricle and the orbicularis oculi muscle. When contracting, it moves the auricle forward. Who could show it better than a picture from Wikipedia?
- Superior ear muscle (musculus auricularis superior). It is perpendicular to the anterior ear muscle. It starts from the supracranial aponeurosis and is attached to the upper part of the cartilage of the auricle. When contracting, in theory, it should lift the ear upward, but it does not fully function due to its, as already mentioned, rudimentary nature.
- Posterior ear muscle (musculus auricularis inferior). We mark the beginning of this muscle on the nuchal fascia, and it is attached to the back of the auricle (more precisely, where the base of the auricle is). If you try to shorten it very hard, the auricle will pull back slightly.
- Anterior ear muscle (musculus auricularis anterior). It starts from the temporal fascia and supracranial aponeurosis, and is attached to the skin of the auricle just above the anterior cartilage. To put it very simply, this muscle lies between the auricle and the orbicularis oculi muscle. When contracting, it moves the auricle forward. Who could show it better than a picture from Wikipedia?
By the way, another cool picture. A tablet like this is common in many medical universities. It shows triangles and neck muscles, you've probably seen one like this. So, on this tablet the posterior ear muscle is very clearly visible, I noted it: 
So, that was an overview of the facial muscles. The review, of course, turned out to be incomplete, but this is usually enough to get at least 4 in the head muscles (provided that you also know chewing muscles). My article did not include quite a few muscles:
- Depressor anguli oris muscle;
- Muscle depressor labii superioris;
- Levator labii superioris muscle;
- Mental muscle...
...And several others. You can learn them using Sinelnikov’s atlas, your lectures and Wikipedia. By the way, about Wikipedia. Some muscle groups on this resource are beautifully designed and shown, taking into account completely correct anatomical classifications. As you may have noticed, I took several drawings from there for my article - they are too good.
The most important question is - there is a lot of text, there are also pictures, how to teach? You need to learn the anatomy of facial muscles as follows. After reading the information about each muscle, you need to sketch it on a rough piece of paper and sign the most important information, such as topography (origin, attachment, function) and some special words that will immediately help you navigate. For example, when I heard the word “grin,” everything that needed to be said about the zygomatic muscles immediately popped into my head.
An important point is that muscle drawings must be done not separately from all other anatomical structures, but on them. That is, you sketch out the contours of the skull with a simple pencil, and use a pen to place the muscles on top of them.
It is also very useful to strengthen your knowledge on specific topics with the help of videos. You can easily find videos on our topic today on YouTube, there are a decent number of them. Try to check with authoritative sources (with Sinelnikov’s atlas, for example) when watching videos of other teachers, because everyone can make mistakes, even the coolest anatomists.
Lexical minimum
A mandatory selection of Latin terms for self-control. If you have learned and reinforced the topic “facial muscles of the head,” then you can easily translate each term into Russian and show it in a picture, on a tablet, or on yourself. If you find it difficult to show and translate more than two terms, you need to go through the topic again.
- Musculus epicranius;
- Aponeurosis epicranialis;
- Venter frontales;
- Venter occipitales;
- Musculus orbicularis oculi;
- Pars palpebralis;
- Pars orbitalis;
- Pars lacrimalis;
- Musculus procerus;
- Musculus nasalis;
- Pars transversa;
- Pars alaris;
- Musculus orbicularis oris;
- Pars labialis;
- Pars marginalis;
- Musculus buccinator;
- Corpus addiposum buccae;
- Musculus zygomaticus major;
- Musculus zygomaticus minor;
- Musculus auricularis anterior;
- Musculus auricularis superior;
- Musculus auricularis inferior.
Facial muscles are susceptible to age-related deformities. A change in their condition leads to sagging of the skin, the formation of folds, and the appearance of pastiness. To prevent changes in the shape of the facial muscles, you need to regularly carry out procedures to restore their tone and relax. Performing specialized exercises and massage is an ideal option for preserving youth. Knowledge of the structure of facial muscles will help to carry out these procedures efficiently.
Regular work of the facial muscles normalizes blood supply to tissues, which promotes rapid metabolism and intensive nutrition of the skin with beneficial microelements and vitamins.
Facial changes with age
The more often all the facial muscles are used, the higher their tone, and vice versa. However, hypotonicity is just as bad as hypertonicity. Therefore, the task of any procedures affecting muscles is to bring them to a normal, natural state.
Correct handling of the facial and neck muscles leads to the following positive effects:
- Relaxation;
- Improved skin color;
- Normalization of blood circulation;
- Relaxation of tense muscles;
- General skin tightening;
- Reduction of wrinkles;
- Removing a tired look;
- Cleansing the epidermis;
- Formation of the correct oval face.
Anatomy of the muscles of the face and neck
Most anti-aging practices involve working muscles. Therefore, when performing rejuvenating practices, it is important to know their location.
The anatomy of the human face has a complex structure, the muscles are intertwined, connected to each other, and can be located one under the other, creating the face as it is. There are about 57 muscles on the face that are responsible for the expression of certain emotions and jaw movement. The neck also consists of many interconnected muscles. Conventionally, the facial muscles can be divided into:
- facial expressions;
- ophthalmic;
- mouth and jaw (chewing);
- cervical
Facial muscles are adjacent to bone tissue at one end, and attached to another muscle or skin at the other. This feature determines their mobility. Excessive activity of facial muscles leads to the formation of skin creases called wrinkles. Other types of facial muscles are located on bones and are attached to them through tendons.
The fat layer on the face is small, so the visibility of age-related changes depends directly on the condition of the muscles in this area.
Consider a diagram of the main muscles of the human face and neck.
Atlas of human facial muscles
Functions of the muscles of the face and head
The anatomy of the facial muscles has been thoroughly studied, and their functions are precisely defined; in some cases, the name of the muscles speaks for itself:
- Calvarial muscle(tendon helmet) moves the tendons and scalp, raises the eyebrows, and gathers the skin of the forehead into transverse folds.
- Occipitofrontal pyramidal, is responsible for raising the eyebrows, forming horizontal wrinkles on the forehead. There is one such muscle above each eyebrow, so the eyebrows can move separately from each other. Their movement is combined with the opening of the palpebral fissure, giving the face a certain expression.
- Temporal region muscle moves the jaw in different directions.
- Fibers proud muscles located between the eyebrows and stretch to the frontal area. It helps to wrinkle your nose and move your eyebrows. Its tension leads to the formation of a horizontal wrinkle between the eyebrows.
- Corrugator muscles set them in motion. They pull the inner edge of the eyebrows towards the midline, upward and inward, bringing the edges closer together. Their hypertonicity leads to the appearance of vertical wrinkles between the eyebrows. The eyebrows, under the influence of these muscles, can bend at an angle, creating small folds in the skin, perpendicular to its course. Its other function is to raise the upper eyelid.
- Orbicularis oculi muscle responsible for the narrowing and closure of the palpebral fissure.
- Nasal when contracted, it allows the wings of the nose to move. Its contraction expands and contracts.
- Lacrimal muscle, raising the upper lip and wing of the nose.
- Infraorbital muscle, which raises the upper lip, is extremely important for the appearance of the area under the eyes and the eyes themselves.
- Zygomatic minor, shifts the corners of the mouth to the side and up.
- Greater zygomatic moves the corners of the mouth to the side and up, helps to smile and participates in the appearance of the nasolabial fold.
- Circular mouth is able to tighten the lips, pulling them forward, and compress them.
- Modiolus ensures the interaction of muscles around the mouth, gives the shape of the lower third of the face.
- Laughter muscle Designed to stretch the corners of the mouth. For some, when it contracts, a dimple forms on the cheek. In addition to facial functions, it plays an important role in facial modeling. Proper work with it allows you to correct the oval, raise the corners of the lips.
- Buccal muscle located under the laughter muscle. It supports the cheeks and stretches the mouth opening to the sides. The mouth becomes wider if the muscle is in hypertonicity. Between it and the skin there is a layer of fat. In women, the layer is larger than in men, and in children it is especially developed. With age, the cheek fat pad decreases, creating sunken cheeks.
- Triangular muscle, lowering the corners of the mouth. Its directed movement helps to express sadness, and with hypertonicity the face takes on a gloomy expression.
- Muscle that lowers the lower lip directs it down, gives his face an expression of disgust.
- Submental consists of two parts located under the quadratus muscle of the lower lip. Forms a dimple on the chin if there is distance between this pair. Pulls the lower lip upward, making the expression of the lips arrogant.
Play an important role neck muscles. In addition to the function of movement and head tilt, they influence a person’s appearance. Their sagging or hypertonicity leads to the appearance of a double chin, decreased elasticity and gray skin color, which are expressed by bags under the eyes and general swelling (pasty).
Facial muscles on video
You can see how facial muscles work in 3D format in the video:
You can learn in detail about the anatomy of the facial structure and the physiology of its aging. The author talks in detail about the causes of age-related changes, gives recommendations and a set of exercises to restore youth. Download the book by N.B. Osminina “Anatomy of facial aging or myths in cosmetology” can be found at.
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